Pregnancy and Postpartum · Depression · Mental Health · Parenting

Will I have postpartum depression again?

For anyone who has survived postpartum depression, you know how painful and unsettling life felt after your baby arrived. During that first year, you are overwhelmed with feelings of irritability, helplessness, anger, rage, sadness, and anxiety (just to name a few). The fear of ever facing this experience again causes many parents to hesitate about having another child. There is nothing that they want to avoid more than those intrusive thoughts, hours of sobbing, or crippling anxiety. I hope this post will offer you some support and guidance in considering your next steps.

You have the right to say no

Pressures for nuclear families are constantly pushed at parents. I hear many well-intentioned family members asking when moms will be pregnant again, and expressing concerns that their children will be lonely if they do not have siblings. Firstly, let’s all agree that these folks need to chill out. No one should tell you what your family should look like. There are many, many single-child families who have wonderful, happy lives. If you have decided that one is enough, please rest assured that you are making the right decision. After all, it is your body, your lifestyle, your family, your income, and all of your resources. While loved ones may comment, at the end of the day, you have to take care of this little person. You are absolutely entitled to decide that you don’t want this option.

Many factors will influence your mental health

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There are a lot of vulnerabilities that influence mental health. When it comes to postpartum depression, the list can include: poor sleep, stress, hormonal changes, physical wellness, relationship struggles, financial worries, history of mental health, multiple children, and complicated pregnancies/deliveries. This is not an all-encompassing list; however, it does address some important influencers during the perinatal period.

History of mental health struggles (including postpartum depression with your first child) is only one contributing factor. Postpartum depression symptoms typically decrease between one postpartum period to the next, showing that we have the capacity for healing. Research has found that there is high variability of whether parents’ symptoms of postpartum depression increase or decrease in future deliveries.

What does this all mean for you? Just because you had postpartum once does not guarantee you will have it again. If you had experienced significant distress in your first experience, err on the side of caution and seek support as soon you are pregnant. Postpartum depression is treatable. Your recovery experience improves when you do not prolong suffering.

You know more today than you did during your first pregnancy

Many first time parents feel nervous and uncertain about taking care of their babies. I mean, why wouldn’t we? If we are not surrounded by babies all the time, or if it’s not within our line of work, it makes sense that we are not experts on this topic. Since there are many unknowns during the first year with our child, we can feel inundated with worries about the baby’s well-being and our own capacity to parent.

Postpartum depression. perinatal mental health. Worries about having a second child.

As cliché as this may sound, practice makes perfect. Consider how vulnerable you felt when you first took your little one home versus how you felt six months or even 2 years in to parenting. You’ve gone from feeling incompetent to suddenly having a knack for diaper changes, effortless feedings, and confidence in bedtime routines. That level of skill and knowledge took you weeks of trials and errors before you could confidently move forward. This is the beauty of having a second child. That level of uncertainty and worry still exists; however, it is significantly more muted than the first time experience. You are much faster at handling all of those questions from your first time simply because you have the experience in your tool belt.

Understand your vulnerabilities

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As painful as it may seem, I encourage you to sit down and reflect on your first-time experiences of pregnancy and postpartum months. What was hardest for you? When did you struggle the most? Did you have support available, and was your support team actually helpful? Were you able to rely on your partner? What kept you down on your hardest days? When did circumstances improve? Did you use medication, or were you able to manage without? What resources did you bring in the last time?

Knowing what was hard the first time can give us a working plan of how to handle the situation differently this time around. Some moms are so clear that they do not want to have another child while COVID-19 is still a concern. Other moms are aware that sleep training is what they needed in order to feel more stable. Many moms know that attending counselling and couples counselling helped them work through anxieties as they surfaced. It sucks to have to learn from our hardships. Knowing what did and did not work can help you decide what to do differently this time around. When you have the awareness, you have a lot more control and influence over the situation.

Find a community

The stats are very clear. About one in seven mothers and one in ten fathers experience postpartum depression. Yet, we live in a world where we suffer silently. Joining a support group, or connecting with other safe parents is one of the best things that you can do for your system. Let go of the pinterest-moms in your world. Don’t try and find validation from your next door neighbour who always looks well-presented and has the most well-tempered baby. These people will (hopefully, unintentionally) make you feel lousy. FInd parents who help you feel less alone. Your worries are similar to the stressors that others have also experienced. Find those who have survived postpartum mental health, and hear about their experiences. Learn what worked for them to not only have this level of encouragement, but to also find strategies that you want to employ.

If you experienced postpartum depression with your first child, it’s highly likely that you felt overwhelmed or frustrated with parenting. The circumstances are much more complicated if you are a single parent, or if your partner works long hours. While this is no one’s fault, feeling isolated in your parenting is an important factor to keep in mind. Gather your support team and come up with a plan that will support your needs. This may involve asking your mother to stay with you for the first week, or asking a friend to check in daily. You might contact resources like a lactation consultant, a postpartum doula, or a sleep-training specialist earlier into your postpartum experience. Your support team can be informal like friends or family, or professionals. Irrespective, these folks are helping you to fill in the gaps. There is a reason for the saying “it takes a village to raise a child.” No one should be expected to do it all alone.

Move your body

When we struggle with depression, our body wants to shut down, isolate, hide, or retreat. This makes a lot of sense when the world feels too much. Of course, you want to escape and disengage. It’s far safer in your home than to socialize, take the baby out, or pretend that everything is normal. When we stay hidden away, we can get caught in this safety net for a long time. Sure the world may feel safer when you’ve stayed away, but it’s also felt bleak and painful everyday that you’ve been hidden. If you are ambivalent to have another child because of this shut down experience, there are strategies that can help. There are many coping strategies that can be employed to use address anxiety and depression. The key is to find the right set of skills that fit for you.

One effective distress tolerance skill is to increase our activity level. I get that exercise is not everyone’s cup of tea, but I want to emphasize how quickly it can help you in getting out of a funk. When it comes to a crisis situation, getting even 2-5 minutes of intense exercise will force your physiology to change. Your shut down system is forced to be more alert with this sudden intensity. After this burst of working out, we have about 15-20 minutes of reprieve. We feel more regulated and think more clearly. This gives you a chance to look at your current setup and schedule. You may find you have more capacity to get out of your room, go for a walk, or call a friend. Things that felt unmanageable, suddenly feel more accessible.

Seek treatment

Postpartum mental health is not based on will power. Crying everyday, or stressing about spending time alone with the baby is not a normal part of parenthood. If this is your experience, I want you to know that it does not have to be like this. Postpartum myths can prevent us from seeking out help, and I can appreciate that these are genuine barriers. Whether it’s due to internal shame, external pressures, cultural expectations of motherhood, or any other factors, it can be hard to shift away from this perspective. However, the best part of working in perinatal mental health is that I know it gets better. I see mothers improving within a year or two of delivery. This may involve regular therapy, a community of support, various coping strategies, use of medication, or a combination of interventions. With support, postpartum mental health can improve.

Postpartum depression does not have to define your experience

If you are feeling scared of having postpartum depression again, please reach out. Just because you struggled with your mental health the first time does not mean it will happen again, or that it has to get as bad. There are numerous preventative and reactive interventions that we can incorporate to help you feel more resilient. Reach out when you feel ready.

Take care,
Kasi

Pregnancy and Postpartum · Mental Health

Postpartum OCD: The Curse of Never-Ending Scary Thoughts

While postpartum depression and anxiety have become more widely-understood, there is still limited research about postpartum obsessive-compulsive disorder. This mental health struggles occurs in approximately 1-10% of parents. Since postpartum OCD presents as excessive worrying and helplessness, it is commonly misdiagnosed as anxiety, or worse, it is dismissed as “normal worrying”.

person washing his hand
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When you think of OCD, your mind may jump to stereotypical examples like excessive hand washing due to a fear of germs. With postpartum-OCD, parents are often struggling with scary thoughts regarding the safety and well-being of their baby. As a forewarning, some of the examples shared below can be triggering. Please read with caution, and reach out if needing support.

The first element of OCD: Obsessions

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There are two key components that make up OCD. The first is obsessions. Obsessions involves intrusive and distressing thoughts, images, or beliefs that continue to repeat incessantly. Individuals struggling with obsessions do not feel in control of these thoughts, and are quickly overwhelmed. Common OCD obsessions include:

  • needing order or symmetry
  • fear of harming yourself or other people
  • unwanted sexual thoughts
  • religious obsessions (e.g. fear of offending God)
  • fear of limited or lack of control (e.g. acting on impulsive urges to shoplift)

Common obsessions with Postpartum OCD:

crop mom dressing newborn on bed
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  • Contamination fears (e.g. bottles not being cleaned thoroughly)
  • Fear that baby will get sick or die (e.g. sudden infant death syndrome, car accidents)
  • Sexually intrusive thoughts (e.g. what if I am turned on when changing my baby’s diaper?)
  • Concerns about hurting the baby. For example:
    • What if I drop the baby and her head cracks open?
    • Intrusive thoughts about stabbing/shaking the baby
    • Image of drowning baby in bathtub
    • Urge to scream at baby
  • Concerns that others may harm the baby
  • Stress about making the wrong decisions (e.g. feeding the wrong food)
  • Rigidity to schedules/routine (e.g. nap times, feed times)

The second element of OCD: Compulsions

An individual with OCD is aware that these obsessions are not valid or logical. However, because the images or thoughts are so distressing, it feels important to get rid of them quickly. This is how compulsive behaviours start. When an obsession becomes too much to handle, compulsive behaviours are used to manage them. If you’re scared of germs, you start to wash your hands. If you’re scared of your baby dying during sleep, you may need to check repeatedly during the night to ensure safety. These compulsions are not effective in actually eliminating or addressing the fear; however, they provide a quick fix in that moment. Because the intrusive thought comes back quickly, the compulsive behaviour is repeated in order to help the individual calm down.

Common Compulsions with Postpartum OCD

When it comes to postpartum OCD, these parents are overwhelmed by the idea of harming their baby or being unable to protect their baby. Compulsive behaviours involve any means in which to offer their baby protection. Examples include:

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  • Avoidance of the baby
  • Checking repeatedly to see if bottles/supplies are clean
  • Excessive-reassurance seeking from health care professionals to confirm that baby is safe and healthy
  • Removing all sharp objects from the home
  • Avoiding any news or media related to child abuse (due to fear of being turned on)
  • Refusing to give baby a bath
  • Refusing to change diapers (due to fear of sexually abusing baby)
  • Avoiding breast feeding or eating certain foods to prevent contamination
  • Excessive praying
  • Isolating baby from loved ones
  • Not driving in the car with baby

Some compulsive behaviours seem normal. After all, double checking that the bottles are clean, or peeping in to the nursery to ensure your infant is asleep are perfectly normal tasks that all parents practice. The concern with compulsions is when these behaviours are done repeatedly. When intrusive thoughts are too distressing and compulsions take up a large chunk of time, our quality of life starts to suffer.

The commonality of intrusive thoughts

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Most of us, irrespective of having a mental health diagnoses, will have disturbing thoughts from time to time. In fact, intrusive thoughts happen to approximately 80% of new parents. We’ll have a fleeting thought about falling off a balcony, driving into oncoming traffic, or yelling at our family members. When we are not fraught with distress and fatigue, we can usually shake our heads and call it for what it is: a strange thought. We may scoff and think it’s odd, but we don’t put too much thought into it, and can move on. For those with postpartum OCD, intrusive thoughts are so distressing that these parents assume there is some truth or meaning to these obsessions. Rather than shaking their head and saying “what a weird thing to think”, they become overwhelmed with guilt and shame at ever considering these thoughts.

Fears in reaching out

In a previous post, I had talked about some of the barriers that prevent parents from seeking help. One of the biggest blocks in reaching out for help is the fear that expressing these intrusive thoughts will lead to a call to the Children’s Aid Society. For those who struggle with this fear, I would like to reassure you that having a scary thought does not mean you are going to act on them! Parents with postpartum OCD have the best intentions for their children. They are overwhelmed by the fear of causing any harm that they are willing to practice whatever forms of compulsive behaviours to avoid this potential issue. Seeking help does not mean a call to the authorities.

postpartum OCD and anxious thoughts
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Postpartum OCD is not a “mom’s issue”; it can also be experienced by dads, adopted parents, and other caregivers. If you or a loved one is experiencing intrusive thoughts during the postpartum months, please do not stay silent. Postpartum mental health is treatable. If you are concerned about your own symptoms, but are not ready to talk, you can fill out the Yale-Brown Obsessive-Compulsive Scale to complete a self-assessment.

Take care,

Kasi

Kasi Shan, MSW, RSW
Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.